ELIGIBILITY/BENEFITS VERIFICATION

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Insurance companies regularly make policy changes and updates in their health plans. So we save you the hassle of staying updated all the time and instead our dedicated staff co-ordinates with the medical billing company or the provider to verify if the patient is covered under the new plan to get maximum reimbursement.

Verifying a patient’s insurance eligibility and benefits prior to the appointment time is vital toward insuring that treatment plans are properly prepared and that a patient’s expectations relative to fees due are clearly explained and understood by them. It also insures that procedures will not be performed that are later denied and found to be the responsibility of the patient. To date, there is no electronic eligibility/benefits service that provides the detailed information needed by a HEALTHCARE practice to make an informed decision with regard to treatment of patients. It therefore becomes necessary to involve office staff in the same, a process that reduces the time that should be spent with patients in the reception area or with new patients on the telephone.

At Grandeur Healthcare, through our Eligibility Verifications Services, we:

  • Help in reducing our clients’ revenue cycle
  • Improve collections by reducing write-offs
  • Improve A/R cycles (reduce A/R days) Backlog

We also provide timely and accurate insurance eligibility checks and verify patient benefits information including , but not limited to, maximums available, deductibles used, exclusions/limitations and individual procedure allowable fees. Our team then enters this data into your practice management software and attaches the appropriate plan to the patient, all without the involvement of your office staff. It is important to note that all calls are recorded and can be retrieved for review should questions arise in the future.

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Our team verifies coverage on any primary or secondary payers by utilizing payer websites, automated voice response systems, or by making phone calls to payers. We also offer real-time pre-authorization services for walk-in patients.
Based upon discussions with your administrators, Grandeur Healthcare determines the best questions to ask to get the information you require whether it be for new or existing patients; PPO, HMO or Medicaid insurance; or specific specialties (including Medical). In addition, schedules for such verification checks are discussed and agreed upon. Most of our clients require they be done 3-4 days prior to the appointment. Grandeur Healthcare’s team also provides same day eligibility/benefits verification for walk-in and emergency patients and, in some states, for Medicaid patients. Many of our clients ask us to do re-verifications of all patients just before their appointment time to insure they are still eligible.